DR. RANDALL JAY MOORE (NPI# 1992780597) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992780597 |
| Entity Type | Individual |
| Full Name | DR. RANDALL JAY MOORE |
| Credential | M.D., M.P.H., C.P.E |
| Practice Address |
366mdg/sgpf 90 Hope Drive; Bldg 6000 Mountain Home Afb ID 83648 |
| Mailing Address |
Po Box 1338 Mccall ID 83638-1338 |
| Practice Telephone | 2088287401 |
| Mailing Telephone | 8087720871 |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2018-05-29 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2083A0100X |
Preventive Medicine Specialization: Aerospace Medicine |
4463 | MT | Allopathic & Osteopathic Physicians |
| Y | 2083A0100X |
Preventive Medicine Specialization: Aerospace Medicine |
M-4332 | ID | Allopathic & Osteopathic Physicians |
| N | 2083A0100X |
Preventive Medicine Specialization: Aerospace Medicine |
17958 | AZ | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1129 Rim Drive, Mccall, ID 83638 | 8087720871 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457421877 | Randall B. Moore | Chiropractor | 260 S 112th St, Lafayette, CO 80026-9031 | 2006-11-09 |
| 1740368067 | Randall Alan Moore | Pharmacist | The Nebraska Medical Center Clinic Pharmacy, 989200 Nebraska Medical Center, Omaha, NE 68198-9200 | 2006-11-02 |
| 1790245496 | Randall Edward Moore | Registered Nurse | 2250 Soquel Ave, Santa Cruz, CA 95062-1402 | 2019-03-20 |
| 1013386945 | Randall Moore | Dentist | 141 Milbank Ave, Greenwich, CT 06830-6616 | 2015-09-22 |
| 1376721621 | Randall James Moore | Pharmacist | 4405 Vandever Ave, 1st Fl Pharmacy, San Diego, CA 92120-3315 | 2008-02-07 |
| 1598894073 | Randall Chris Moore | Physical Therapist | 500 London Ave, Marysville, OH 43040-5512 | 2007-03-02 |
| 1669537304 | Randall R Moore | Pharmacist | 720 16th Ave, Lewiston, ID 83501-3768 | 2006-12-22 |
| 1841351285 | Randall Moore | Family Medicine | 6760 Mission Rd, Everson, WA 98247-9749 | 2006-12-12 |
| 1205927274 | Randall B Moore | Surgery | 3791 Katella Ave, #201, Los Alamitos, CA 90720 | 2006-09-27 |
| 1245291228 | Randall F. Moore | Psychiatry & Neurology | 2401 S 31st St, Temple, TX 76508-0001 | 2006-03-30 |
| Street Address |
366MDG/SGPF 90 HOPE DRIVE; BLDG 6000 |
| City | MOUNTAIN HOME AFB |
| State | ID |
| Zip Code | 83648 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851528392 | Amy Jo Glover | Military Health Care Provider | 90 Hope Dr. Bldg 6000, Mountain Home, ID 83648 | 2009-06-11 |
| 1306051065 | Thomas Michael Smith | Social Worker | 90 Hope Dr Bldg 1900, Mountain Home Afb, ID 83648 | 2007-05-14 |
| 1316005143 | Ronald Wesley Bailey | Radiology | Mountain Home Afb Medical Group, 90 Hope Drive, Building 6000, Mountain Home Afb, ID 83648 | 2006-12-05 |
| 1356325666 | Joseph Carroll Skinner Jr. | Nurse Anesthetist, Certified Registered | 366 Mdos, Sgosa, 90 Hope Drive, Mountain Home Afb, ID 83648 | 2005-11-30 |
| 1023007846 | Craig Loyd Folsom | Dentist | 90 Hope Dr Bldg 6000, Mountain Home Afb, ID 83648 | 2005-10-14 |
| 1477547271 | Ron Stumbo | Pharmacist | Mountain Home Afb, Mountain Home Afb, ID 83648 | 2005-09-07 |
| 1154315943 | Georgette Ann Trezvant | Social Worker | 366 Medical Operations Squadron, 90 Hope Drive, Bldg 6000, Mt. Home Air Force Base, ID 83648 | 2005-09-07 |
| 1265948897 | Alyse Marie Denittis | Physician Assistant | 90 Hope Dr, Mountain Home Afb, ID 83648 | 2017-12-19 |
| 1891224473 | Jared Getzlaff | Military Health Care Provider | 90 Hope Dr, Mountain Home Afb, ID 83648 | 2017-06-07 |
| 1548796527 | Derek J Dutson | Dentist | 90 Hope Dr, Mountain Home Afb, ID 83648 | 2017-05-11 |
| Find all providers in zip 83648 | ||||
| Taxonomy Code | 2083A0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Preventive Medicine |
| Specialization | Aerospace Medicine |
| Aerospace medicine focuses on the clinical care, research, and operational support of the health, safety, and performance of crewmembers and passengers of air and space vehicles, together with the support personnel who assist operation of such vehicles. This population often works and lives in remote, isolated, extreme, or enclosed environments under conditions of physical and psychological stress. Practitioners strive for an optimal human-machine match in occupational settings rich with environmental hazards and engineering countermeasures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Preventive Medicine, 2007. http://www.abprevmed.org/. American Osteopathic Board of Preventive Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Preventive Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Preventive Medicine. |
| City | MOUNTAIN HOME AFB |
| Zip Code | 83648 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.